Every month, under normal circumstances, women in their ‘child-bearing’ years experience their monthly ‘menstrual period’.
This blood loss comes about as a result of the monthly shedding of the lining (a.k.a. the ‘endometrium’) of their uterus or womb. On a monthly basis the womb is re-lined with a fresh endometrium and prepared for the implantation of a fertilised ovum which Mother Nature, who is forever planning to have more of us around, would eventually turn into a baby.The growth and preparation of the endometrium for the implantation of a fertilised ovum is under hormonal control and the principal hormones involved are oestrogen (or estrogen) and progesterone.
These hormones are produced by the developing ovarian follicle which, when it has released the ovum (which is what happens at ovulation) develops into the corpus luteum. In the first part of the monthly cycle ( up to the time of ovulation ) oestrogen is produced in large amounts and then, after the ovum has been released form the follicle, progesterone (literally a progestational agent) is produced which helps prepare the endometrium for the implantation of a fertilised ovum and also helps to ‘maintain’ the preegnancy in existence at this early stage.
What is premenstrual syndrome?
Premenstrual syndrome consists of any symptoms which a woman experiences on a regular monthly basis in association with her menstrual period. Not every patient experiences PMS symptoms every month and also the severity of the symptoms may vary hugely also. Some people tell me that they only get ‘bad’ PMS every second or third month.
Premenstrual syndrome has been divided into four types: In real life I find the types overlap all the time and are by no means as clear-cut as a classification system might suggest. In my experience the majority of patients present a ‘mixed’ symptom picture but, for the record the classifications are as follows:
PMT-A ( ‘Anxiety’): Anxiety, irritability, insomnia, depression
PMT-C (’Craving’): Craving for sweets, increased appetite, sugar ingestion may lead to headache, palpitations, fatigue or fainting
PMT-D (’Depression’): Depression, forgetfulness, confusion, lethargy
PMT-H (’Hyperhydration’): Weight gain above 1.4kg, breast congestion and tenderness, abdominal bloating and tenderness, oedema of face and extremities
What do women experience if they are suffering from premenstrual syndrome?
Different women may have quite different experiences of premenstrual syndrome - the term is really is not a very useful descriptive label in that it suggests that people have semi-identical experiences of PMS. The symptoms will usually consist of several of a range of complaints including : anxiety, tearfulness, aggression, irritability, insomnia, abdominal bloating, abdominal distension, abdominal pain, diarrhoea, constipation, swelling of the hands, the feet or of the whole body, sugar cravings, swollen breasts that may be very tender to the touch or, in more severe cases, the breasts may become spontaneously painful at rest even if they are not touched and for a minority of women the breast pain and tenderness may cause or add to sleep problems. Sugar and carbohydrate craving is a significant problem, also for about 40% of women.
Who gets premenstrual syndrome?
While period pain tends to be the most-significant period-related problem that bedevils the teenager and twenty-something women the patient presenting with premenstrual syndrome is frequently someone in her mid-thirties. On occasion she may remark that her PMS began after the birth of one of her children. Of course that does not cast a magical ring of protection from PMS around those who have not had children!
How much of the month do symptoms persist in Premenstrual Syndrome?
If we call the day a woman’s period begins day 1 and presume that she is fortunate enough top have a regular menstrual cycle then, for most average PMS sufferers symptoms will usually not begin until around day 24 and will generally disappear as the period begins which is going to be day 28/day 1. There will, though, be a minority of women who will continue to have mood and or physical symptoms that will last for the first one, two or three days of their monthly period. This is the exception, though, and most women breathe a sigh of relief when their period begins, though as we all know, some individuals with PMS also have severe period-related symptoms to deal with, also.
Another group of PMS sufferers may have symptoms lasting 2-3 days duration around day 11 or 12 which then may go away again to return sometime before the period arrives and the symptoms will usually persist until the bleed starts. The symptom return date is variable and may be anywhere from day 15 or 16 to day 26 or 27.
There will be some other patients who have symptoms that persist form day 12 or 13 until their menses arrive. Even more extreme will be those who get symptoms beginning day 12 or 13 which last until day 2 or 3 of the next cycle. As you can see some people have their problems so spread out over so much of the month that, allowing for feeling somewhat below par at period-time itself they end up having very few days where they really feel well. This can play havoc with a woman’s sexual life. Happily the vast majority of PMS sufferers are not so severely affected.
Premenstrual syndrome and Mood Problems
Almost any woman may feel a bit sensitive or emotionally fragile for an hour or two to a day or two just before her period comes on. Most women accept this as normal and reasonably bearable.
Some people, though, will experience substantial mood changes associated with PMS. I ask patients : Which type of emotional symptoms predominate :do you become a fading over-sensitive overly-emotional lily or a tigresses? Polite, thoughtful people may turn into raging tigresses and ‘eat the head off ‘ of those they come into contact with, whom not totally unexpectedly, will include colleagues, husbands and children. It’s usually the relationships with colleagues and children that trigger the patient into seeking help. Patients will often relate to me : “My husband / partner understands that the PMS me is not the real me but my three under-7s don’t realise that, and neither do a lot of my / friends/clients/ patients/colleagues”. The emotional range varies hugely from severe aggressiveness to inconsolable tearfulness and depression. An occasional unfortunate individual is dealt the extra-difficult hand of finding that they are both aggressive tearful and depressed all at the one time. Thought processes and memory may temporarily be very sluggish.
Insomnia and anxiety will trouble quite a few people. Some people will become temporarily quite depressed. Food cravings will be troublesome for a substantial number of people and they find that they just ‘pig-out’ and then regret it afterwards. Usually the cravings are for chocolate, sweets or cakes.
Premenstrual Syndrome and Physical Problems
Again the range of symptoms is broad.
Premenstrual symptoms which a large majority of women will experience and generally not severe enough to qualify for the label ‘PMS’
Some people will get vague tummy problems with mild accompanying diarrhoea or constipation just before the onset of their menses. Some individuals who normally experience irritable-bowel-type symptoms form time to time will notice that these symptoms are somewhat exacerbated before their periods. There may be other transient symptoms such as mild breast tenderness. Generally most people will cope well with minor symptoms such as these. These symptoms would be classified as ‘mild’ inconvenience not severe enough to be classified as PMS.
Premenstrual symptoms severe enough to be classified as PMS:
Some individuals will get severe abdominal bloating , pain or diarrhoea. Breast changes as outlined above may be severe. As well as experiencing cravings for particular foods individuals may find that they need to eat very frequently just to maintain semi-adequate energy levels. Nausea and vomiting tend to be problems that occur with the onset of the period rather than, strictly speaking, being part of a PMS symptom complex.
Premenstrual Syndrome: What is on offer conventionally? Vitamin B6 or pyridoxine has almost slipped into the mainstream as has evening primrose oil which contains omega-6 essential fatty acids. The contraceptive pill is also frequently prescribed by GPs and gynaecologists and, if patients find that they can tolerate it well, they generally find it useful. Diuretics or water pills were used a lot in the 1980s but are not used much nowadays. Tranquilisers and antidepressants are sometimes offered.
There is also the routine advice which is to reduce intake of caffeine, alcohol and refined sugars beginning three days prior to symptom onset.
Premenstrual Syndrome: What is on offer in an integrative medical context ?
The integrative approach, above all, tries not to be doctrinaire and tries to take the ‘whatever works and is safe approach’ while attempting, as far as is feasible, to treat the cause and not just the symptoms.
Progesterone levels may be of significance and liver detoxification plays a potential role in this aspect.
A patient suffering from PMS, especially if there is a substantial anxiety component ( sometimes referred may have problems affecting her progesterone levels during the premenstrual phase and it is almost always worth measuring a progesterone level around day 19-21 of the cycle. The liver is important in ‘balancing’ estrogen and progesterone and it may have become sluggish - please see the section of this website on Sluggish Liver Detoxification - and it may need a bit of help in its hormone-balancing abilities. It is also possible to biochemically measure liver detoxification ability.
If a patient is suffering from recurrent bowel symptoms or irritable bowel syndrome this may also be exacerbating their premenstrual syndrome.
If a patient has significant bowel symptoms then, in my opinion, these are probably affecting the situation negatively and the probable mechanism is that low-grade toxins from the bowel are negatively affecting the liver’s detoxification capacity by overloading it and distracting it from its hormone-balancing work.
Recurrent vaginal candidiasis
While not elevating the treatment of chronic or recurrent vaginal candidiasis as the cure for all female ills an observational study published as far back as 1987 found significant benefit to patient’s PMS from treating their persistent vaginal candidiasis.
It is recommended that the intake of animal protein and fatty foods generally is reduced.
Nutritional supplementation also has a role to play a role in the treatment of premenstrual syndrome.
There is evidence that vitamin B6, Magnesium, Vitamin E, Calcium, Zinc, omega-6 essential fatty acid supplementation may help.
Can homoeopathy help?
In my opinion homoeopathy may be very helpful but I believe that it is most effective when used is as one part of the treatment in a planned approach which also takes into account the complete medical, gynaecological and biochemical picture.